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At least 19 recordsLinked to original sources
PubMed1991

The effect of chain ownership on nursing home costs.

Although it is commonly assumed that chain ownership will result in lower costs due to economies of scale, the empirical evidence with respect to the effect of chain ownership on nursing home costs is mixed. Chain for-profit nursing homes will have a cost advantage over independent for-profit homes only if there are firm-level (multiple-home) economies of scale. For the study population of Texas nursing homes in 1983, cost structures differed sufficiently across ownership types to warrant estimating separate cost functions by ownership type. The results indicate that, when other factors affecting cost are held constant, chain homes have lower average costs than independent homes at intermediate and high levels of output, but higher average costs at low and very high levels of output. The results highlight the importance of considering whether or not to pool data across ownership categories when estimating nursing home cost functions.

Costs and Cost Analysis↗
PubMed1990

Validating survey responses to questions about gun ownership among owners of registered handguns.

While survey-based data on firearm ownership are essential for epidemiologic studies of the relation between gun ownership and injuries, the validity of respondent answers to questions about gun ownership has not been confirmed. In order to assess the accuracy of interview data about firearms, in June to August 1987, the authors attempted to contact residents of 75 homes in the cities of Memphis, Tennessee and Seattle, Washington listed as the address of the owner of a recently registered handgun. Despite problems with inaccurate registration data, contact was ultimately made with 55 households, 35 of which consented to a general interview that included a series of questions about gun ownership. Respondents in 31 of these 35 households (88.6%) readily acknowledged that one or more guns were kept in their home. Respondents in three of the remaining four households (8.6%) stated that guns were recently kept in their homes but were no longer kept there. Only one respondent (2.9%) denied categorically that guns of any kind were kept in her home. The authors conclude that, at least among registered gun owners, respondent answers to questions about gun ownership are generally valid and that survey data of this type can be utilized with confidence.

Adult↗
PubMedDate not supplied

A survey of attitudes toward responsible pet ownership.

The concerns of medical and community officials about responsible pet ownership have increased. Before a practical solution can be found for irresponsible ownership and community health problems associated with pet populations, the public's attitudes on issues related to responsible pet ownership must be determined. Such issues include attitudes on dog and cat overpopulation, potential public health problems associated with pet populations, and methods of controlling pet populations and stray animals. Responses to a questionnaire were used to evaluate the attitudes of 910 pet owners and nonowners toward factors comprising responsible pet ownership. The median age of the respondents was 33 years; 414 (45 percent) were men, and 496 (55 percent) were women. At the time of the study, 18 percent owned a cat and a dog, 35 percent owned only a dog, 11 percent showed only a cat, and 36 percent were nonowners. Not only the sex of the respondent but also the category of pet ownership affected opinions on overpopulation of dogs and cats, nuisance and pollution problems associated with these animals, and methods of controlling pet populations in the community. For example, owners agreed strongly on family planning for pets, but a majority of male owners stated that they would not have their dogs neutered.

Adolescent↗
PubMed1992

Ownership and performance of outpatient substance abuse treatment centers.

BACKGROUND: Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. METHODS: Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. RESULTS: Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. CONCLUSIONS: There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units.

Financing, Organized↗
PubMed1992

Ownership and organizational performance. A comparison of technical efficiency across hospital types.

Using a national data base of urban hospitals, the effect of ownership (government, nonprofit, and for-profit) on the technical efficiency of hospitals was examined. Efficiency scores were computed using a method called data envelopment analysis. Controlling for environmental and hospital characteristics, for-profit hospitals were found somewhat less frequently and government hospitals consistently more frequently in the efficient category. When examining highly inefficient hospitals as a percentage of those receiving inefficient scores, for-profit hospitals appeared to be highly inefficient relative to the other ownership forms. Government and nonprofit hospitals were somewhat indistinguishable from one another regarding their percentages of highly inefficient scores. For-profit hospitals also tended to use supply and capital asset (hospital size) inputs less efficiently, and service and labor inputs more efficiently than hospitals in the other ownership categories.

Efficiency↗
PubMedDate not supplied

Effects of type of ownership of skilled nursing facilities on residents' mortality rates in Illinois.

The effect of ownership on the quality and cost of care in skilled nursing facilities (SNFs) was examined using unadjusted and adjusted mortality rates for such facilities in Illinois for the 1986-87 reporting year. Results indicated that when using unadjusted mortality rates, for-profit facilities had much lower rates than either government-owned or nonprofit SNFs. When mortality rates were adjusted, using available measures of intervening variables, differences by type of ownership disappeared. The higher percentage of discharges to general hospitals exhibited by for-profit facilities, compared with other types of facility ownership, appears to have the strongest effect on SNF mortality rates.

Aged↗
PubMed1990

Previous pet ownership and Paget's disease.

The relationship between pet ownership and Paget's disease (PD) of bone was investigated in 112 patients with PD who were matched with a similar number of community-based controls. There was a significantly increased frequency of dog ownership by patients with PD aged less than 60 years. Multivariate logistic regression analysis revealed that there was a significant age-related increase in risk of PD associated with past or present ownership of either dogs or cats, with younger patients having the greatest risk. These results suggest that slow virus infection of osteoclasts by paramyxoviruses acquired from pets may contribute to the development of Paget's disease in the younger patient.

Age Factors↗
PubMed1990

Paget's disease of bone and previous pet ownership in the United States: dogs exonerated.

Paget's disease of bone is currently believed to be the result of a paramyxovirus infection of osteoclasts. Previously reported immunohistological data have suggested that a virus resembling either the measles virus or a respiratory syncytial virus is the probable causative agent, but no organism has been isolated or definitively identified to date. A recent study reporting an increased exposure to dogs during childhood and adolescence in a small series of cases from the North West of England proposed that a canine virus, possibly distemper, might be the primarily infectious agent. To study this hypothesis further, we examined prior dog and cat ownership from childhood through adulthood in 433 cases of Paget's disease and an equal number of matched controls living in the US. We found no differences related to prior pet ownership. We conclude that past dog (or cat) ownership is not a risk factor for the development of Paget's disease.

Adolescent↗
PubMed1992

[Clear connection between gun ownership and suicide. 92 per cent of attempts result in death].

In a retrospective study involving 20 police districts in Sweden, 348 completed or attempted suicides with firearms were found to have occurred during the period, 1976-88. Statistics on civilian firearms ownership were obtained from police authorities. Firearm suicide was found to be significantly correlated to gun ownership, through the 25 per cent increase in gun ownership during the period was not accompanied by a corresponding increase in the overall suicide rate. The head was the primary target in suicide attempts, both with longarms (rifles and shotguns) and with handguns (pistols and revolvers). Handgun injuries were more common among the survivors. Only 4.6 per cent of the victims survived and could be discharged from hospital. Nearly 10 per cent of those using shotguns or rifles used a string, a rod or their toes to reach the trigger; all of them died. Apart from such well-known predisposing factors such as psychiatric disorders or alcohol abuse that were present in 43 per cent of cases, 24 per cent of the victims were found to have had somatic problems instead.

Adolescent↗
PubMed1992

Consequences of physicians' ownership of health care facilities--joint ventures in radiation therapy.

BACKGROUND: Physicians are increasingly the owners of health care facilities to which they refer patients for services but at which they do not practice. We studied such ownership arrangements, known as "joint ventures," in the field of radiation therapy, examining their effects on access, use of services, costs, and quality. METHODS: Because 44 percent of free-standing facilities providing radiation therapy in Florida in 1989 were joint ventures, as compared with 7 percent elsewhere (95 percent confidence interval, 3 to 10 percent), we compared data for Florida with comparable data for the remainder of the United States. We also compared radiation-therapy facilities in Florida that were established as joint ventures with those that were not. Since most data were derived from entire populations rather than from samples, any differences found were of necessity statistically significant. RESULTS: No joint-venture facilities providing radiation therapy were located in inner-city neighborhoods or rural areas, but 11 percent of other free-standing facilities and hospital-based facilities were located in such areas. Among free-standing facilities, joint ventures received 39 percent of their revenues from patients with well-paying insurance coverage, as compared with 31 percent for facilities that were not joint ventures (P < 0.01). The frequency and costs of radiation-therapy treatments at free-standing centers were 40 to 60 percent higher in Florida than in the rest of the United States; there was no below-average use of radiation therapy at hospitals or higher cancer rates that explained the higher rates of use or higher costs in Florida. Radiation physicists at joint-venture facilities (the principal personnel involved in quality control other than physicians) spent 18 percent less time with each patient over the course of treatment than did their counterparts at free-standing facilities that were not joint ventures (P < 0.05). Mortality among patients with cancer in Florida was not lower than the U.S. average, even though joint ventures are much more common in that state. CONCLUSIONS: Joint ventures in radiation therapy appear to have adverse effects on patients' access to care. They also appear to increase the use of services and costs substantially. Some indicators show that joint ventures cause either no improvement in quality or a decline. Our results add to the evidence indicating that physicians' self-referral generally has negative consequences. We recommend legislation to ban ownership of joint ventures by referring physicians. Such legislation needs to be carefully designed in order to achieve its objectives and forestall new, financially abusive arrangements.

Ambulatory Care Facilities↗
PubMed1991

Ownership of research data.

The author reviews the conventional "works for hire" principle that an institution, not its employees, owns the rights to its employees' written products or other forms of expression, including primary research data. This principle is not open to debate as a legal matter. The tough problems giving rise to debates regarding data ownership and access are ethical problems rather than legal ones; these will remain unsettled for some time because at present there is no consensus concerning what constitutes ethical conduct among scholars and scientists and how seriously and in what manner to penalize breaches of that conduct. Access to data is a thorny issue; case histories illustrate the legal and ethical difficulties involved in questions of who has access to information compiled in the course of academic inquiry, and for what purpose. Much depends on the ethics and established procedures of the employing institution, but current case law suggests that a faculty member or institutional researcher does not have any legal right to review the data developed by a colleague. The author recommends that institutions clearly state their policies regarding ownership of data, and presents guidelines for such a policy.

Copyright↗
PubMed1990

Managing physician incentives in managed care. The role of for-profit ownership.

The recent rapid growth of HMOs has resulted in a proliferation of contractual arrangements that offer financial incentives to induce primary care doctors to change the way they practice medicine. The impact of these incentives varies with the different incentives and with the environments in which the incentives are implemented. Although financial incentives exist in some form in the great majority of HMOs, there has been no detailed and valid information available on the way these physician incentives are managed or on the characteristics of the standard operating "climate" in which the incentives exist. This study was designed to measure a firm (organizational) characteristic hypothesized to be related to the firm's effort, ability, or desire to make financial incentives work strongly. The characteristic considered is whether the firm is a for-profit or a not-for-profit organization. The goal of this study was to provide a direct test of the relationship between HMO ownership type and the effectiveness of primary care physician incentives. Results of the study indicate that for-profit ownership does enhance the power (or the need) of management to offer effective rewards for parsimonious use of health care resources.

Capitation Fee↗
PubMed1992

Ownership of direct ophthalmoscopes by medical students.

In September 1986 the Department of Education and Science withdrew the equipment grant for clinical medical students. This coincided with a reduction of 50% in the level of ownership of direct ophthalmoscopes amongst a group of 51 medical students who commenced their medical studies after September 1986 (no longer eligible for the equipment grant), when compared with a group of 63 students (in the same clinical year) who started the medical course before 1 September 1986 and who were hence still able to claim the equipment grant. The majority of non-owners gave lack of finance as the reason for non-ownership. Owners of ophthalmoscopes performed ophthalmoscopy more frequently than non-owners, but the difference did not reach statistical significance.

Education, Medical, Undergraduate↗
PubMed1991

Ownership: a pathography of the self.

With this essay I intend to base a theory of psychodynamics on the concept of ownership. I begin with the crucial but negative notion, unconsciousness, exploring certain ways in which this notion is necessary to any psychodynamic theory. Following Havens (1986), I take the concept of self as supraordinate to the elements of psychoanalytic structural theory. Building upon a unique relationship between the self and the unconscious, I then show that variations in self-ownership suffice to generate the gamut of psychopathological situations. I critique the economic aspect of Freudian psychodynamic theory, suggesting a way to improve upon it. In light of the theory thus elaborated, I examine the problem of deliberate suffering. Finally, I suggest a place of special importance for the present theory in psychoanalysis and psychiatry.

Ego↗
PubMed1992

Physician ownership of physical therapy services. Effects on charges, utilization, profits, and service characteristics.

OBJECTIVE: To evaluate the effects of physician ownership of freestanding physical therapy and rehabilitation facilities on utilization, charges, profits, and three measures of service characteristics for physical therapy treatments. DESIGN: Statistical comparison by physician joint venture ownership status of freestanding physical therapy and comprehensive rehabilitation facilities providing physical therapy treatments in Florida. PARTICIPANTS: A total of 118 outpatient physical therapy facilities and 63 outpatient comprehensive rehabilitation facilities providing services in Florida during 1989. The data from the facilities were collected under a legislative mandate. MAIN OUTCOME MEASURES: Visits per patient, average revenue per patient, percent operating income, percent markup, profits per patient, licensed therapist time per visit, and licensed and nonlicensed medical worker time per visit. RESULTS: Visits per patient were 39% to 45% higher in joint venture facilities. Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians. Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities. Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities. Joint ventures also generate more of their revenues from patients with well-paying insurance. CONCLUSION: Our results indicate that utilization, charges per patient, and profits are higher when physical therapy and rehabilitation facilities are owned by referring physicians. With respect to service characteristics, joint venture firms employ proportionately fewer licensed therapists and licensed therapist assistants to perform physical therapy, so that licensed professionals employed in joint venture businesses spend significantly less time per visit treating patients. These results should be of interest to the medical profession, third-party payers, and policymakers, all of whom are concerned about the consequences of physician self-referral arrangements.

Conflict of Interest↗
PubMed1990

Physician ownership-referral arrangements in the United States.

Physician ownership-investment arrangements are increasingly being subjected to public and professional scrutiny. One view is that some of these arrangements may have distinct beneficial, legitimate effects, possibly including increased availability of health care services and state-of-the-art technology. A contrasting view is that such practices are unethical and may result in excessive utilization of services and concommitant increases in medical costs. Legislation has been proposed in the United States Congress which may severely curtail or prohibit various physician ownership-investment relationships. A serious need exists for the collecting of further quantitative data on this subject.

Ethics, Medical↗
PubMed1990

The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type.

This study used published data to analyse the 1983 distribution of hospitals and hospital beds in South Africa by 'race', geographical area, type of hospital (academic, specialist, general or other) and the nature of ownership (e.g. state, for-profit). Hospitals and hospital beds were found to be inequitably distributed. Overall bed ratios were 150 whites per bed compared with 260 blacks/Asians/coloureds per bed. The distribution of beds by geographical area was 130 people per bed for urban whites, 260 for rural whites and 150, 460 and 300 for urban, rural non-'homeland', and 'homeland' blacks/Asians/coloureds respectively. These differentials are inefficient and unjust, and should be regularly documented to spur their decline. The continued collection of population group information from health service users is required to monitor changes in 'race' disparities. The analysis of distribution by ownership and type suggested that only the public sector is able to provide a hospital service with the appropriate balance of all levels of care for the entire population; but within this sector the dominant position of tertiary care needs to be re-examined. The study highlighted the absence of adequate information on health care resource allocation and utillisation. Appropriate studies in these areas are required and consideration should be given to unifying the planning and management of all hospital resources.

Black or African American↗
PubMed1990

Attitudes toward bicycle helmet ownership and use by school-age children.

To identify attitudes toward bicycle helmet ownership and use, questionnaires were sent to parents of 2178 third-graders; 1057 (48.5%) returned valid responses. Of 931 children who had bicycles, 24% owned helmets, but only 56% of children who owned helmets wore them. Helmet ownership, but not use, was associated with higher parental education. Fifty-one percent of 704 parents of bicycle owners who had not purchased helmets said they had never thought of it, 29% thought helmets were too costly, and 20% felt their children would not wear them. Of 792 children who did not wear helmets, 25% said they did not wear them because their friends did not; 22% never thought about wearing helmets; and 16% found them uncomfortable. Efforts to increase the wearing of helmets should address helmet design, awareness, peer pressure, and cost.

Attitude to Health↗